Top Things to Know: Management of Patients on Non–Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting
Published: February 06, 2017
- As the US population ages, the burden of atrial fibrillation (AF) and venous thromboembolic disease is expected to rise and prescriptions for long-term anticoagulant will increase.
- Data are sparse about how to manage patients on NOACs who are actively bleeding or who are risk for bleeding due to an acute care episode or in the periprocedural setting.
- This scientific statement reviews the literature and offers practical suggestions for providers who manage patients who are actively bleeding and who are at risk for bleeding in the acute care and periprocedural setting.
- The management of life-threatening bleeding is discussed within the scientific statement.
- Specifically discussed are: intracerebral hemorrhage, trauma, and gastrointestinal bleeding,
- The management of patients on NOACs who are at risk for bleeding is also discussed.
- Specifically discussed are: management of patients who overdose on NOACs, patients with acute kidney injury on NOACs, patients with ischemic stroke on NOACs,
- Transitioning between NOACs and other anticoagulants in the acute care setting is addressed, along with periprocedural management of patients on NOACs. Included in this discussion are: cardiac catheterization and percutaneous coronary intervention, Cardioversion of atrial fibrillation, electronic device implantation, cardiovascular surgery, non-cardiovascular surgery, and neuroaxial anesthesia,
- NOACs are no longer novel; they are becoming very commonly used in everyday medical practice.
- Healthcare providers are encouraged to use well-defined protocols developed in collaboration with multiple disciplines to address NOAC dose and continuation or cessation when invasive procedures are required.
Citation
Raval AN, Cigarroa JE, Chung MK, Diaz-Sandoval LJ, Diercks D, Piccini JP, Jung HS, Washam JB, Welch BG, Zazulia AR, Collins SP; on behalf of the American Heart Association Clinical Pharmacology Subcommittee of the Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology; Council on Lifelong Congenital Heart Disease and Heart Health in the Young; and Council on Quality of Care and Outcomes Research. Management of patients on non–vitamin K antagonist oral anticoagulants in the acute care and periprocedural setting: a scientific statement from the American Heart Association [published online ahead of print February 6, 2017]. Circulation. doi: 10.1161/CIR.0000000000000477